Thrombus aspiration in patients with ST-elevation myocardial infarction: results of a national registry of interventional cardiology.

BACKGROUND: We aimed to evaluate the impact of thrombus aspiration (TA) during primary percutaneous coronary intervention (P-PCI) in 'real-world' settings. METHODS: We performed a retrospective study, using data from the National Registry of Interventional Cardiology (RNCI 2006-2012, Portugal) with ST-elevation myocardial infarction (STEMI) patients treated with P-PCI. The primary outcome, in-hospital mortality, was analysed through adjusted odds ratio (aOR) and 95% confidence intervals (95%CI). RESULTS: We assessed data for 9458 STEMI patients that undergone P-PCI (35% treated with TA). The risk of in-hospital mortality with TA (aOR 0.93, 95%CI:0.54-1.60) was not significantly decreased. After matching patients through the propensity score, TA reduced significantly the risk of in-hospital mortality (OR 0.58, 95%CI:0.35-0.98; 3500 patients). CONCLUSIONS: The whole cohort data does not support the routine use of TA in P-PCI, but the results of the propensity-score matched cohort suggests that the use of selective TA may improve the short-term risks of STEMI.info:eu-repo/semantics/publishedVersio

Topographical scattering of waves: a spectral approach

The topographical scattering of gravity waves is investigated using a spectral energy balance equation that accounts for first order wave-bottom Bragg scattering. This model represents the bottom topography and surface waves with spectra, and evaluates a Bragg scattering source term that is theoretically valid for small bottom and surface slopes and slowly varying spectral properties. The robustness of the model is tested for a variety of topographies uniform along one horizontal dimension including nearly sinusoidal, linear ramp and step profiles. Results are compared with reflections computed using an accurate method that applies integral matching along vertical boundaries of a series of steps. For small bottom amplitudes, the source term representation yields accurate reflection estimates even for a localized scatterer. This result is proved for small bottom amplitudes $h$ relative to the mean water depth $H$. Wave reflection by small amplitude bottom topography thus depends primarily on the bottom elevation variance at the Bragg resonance scales, and is insensitive to the detailed shape of the bottom profile. Relative errors in the energy reflection coefficient are found to be typically $2h/H$.Comment: Second revision for Journal of Waterways Ports and Coastal Engineerin

Transverse Spin Structure of the Nucleon through Target Single Spin Asymmetry in Semi-Inclusive Deep-Inelastic (e,e′π±)(e,e^\prime \pi^\pm) Reaction at Jefferson Lab

Jefferson Lab (JLab) 12 GeV energy upgrade provides a golden opportunity to perform precision studies of the transverse spin and transverse-momentum-dependent structure in the valence quark region for both the proton and the neutron. In this paper, we focus our discussion on a recently approved experiment on the neutron as an example of the precision studies planned at JLab. The new experiment will perform precision measurements of target Single Spin Asymmetries (SSA) from semi-inclusive electro-production of charged pions from a 40-cm long transversely polarized $^3$He target in Deep-Inelastic-Scattering kinematics using 11 and 8.8 GeV electron beams. This new coincidence experiment in Hall A will employ a newly proposed solenoid spectrometer (SoLID). The large acceptance spectrometer and the high polarized luminosity will provide precise 4-D ($x$, $z$, $P_T$ and $Q^2$) data on the Collins, Sivers, and pretzelocity asymmetries for the neutron through the azimuthal angular dependence. The full 2$\pi$ azimuthal angular coverage in the lab is essential in controlling the systematic uncertainties. The results from this experiment, when combined with the proton Collins asymmetry measurement and the Collins fragmentation function determined from the e$^+$e$^-$ collision data, will allow for a quark flavor separation in order to achieve a determination of the tensor charge of the d quark to a 10% accuracy. The extracted Sivers and pretzelocity asymmetries will provide important information to understand the correlations between the quark orbital angular momentum and the nucleon spin and between the quark spin and nucleon spin.Comment: 23 pages, 13 figures, minor corrections, matches published versio

Application of EFT at Thermal Energies

We have been evaluated some observables of n-d systems by using pionless Effective Field Theory(\EFTNoPion) and insertion of the three-body force up to next-to-next to leading order(N$^2$LO). The evaluated data has been compared with experimental and the three-nucleon calculation of the total cross section with modern realistic two- and three-nucleon forces AV18/UrbIX potential models calculations.Comment: 3 pages, 1 figure and 1 table. Talk given at 20th European Conference on Few-Body Problems in Physics (EFB 20), Pisa, Italy, 10-14 Sep 200

Improved tolerability of neratinib in patients with HER2-positive early-stage breast cancer: The CONTROL trial

BACKGROUND: Neratinib is an irreversible pan-HER tyrosine kinase inhibitor approved for extended adjuvant treatment in early-stage HER2-positive breast cancer based on the phase III ExteNET study. In that trial, in which no antidiarrheal prophylaxis was mandated, grade 3 diarrhea was observed in 40% of patients and 17% discontinued due to diarrhea. The international, open-label, sequential-cohort, phase II CONTROL study is investigating several strategies to improve tolerability. PATIENTS AND METHODS: Patients who completed trastuzumab-based adjuvant therapy received neratinib 240 mg/day for 1 year plus loperamide prophylaxis (days 1-28 or 1-56). Sequential cohorts evaluated additional budesonide or colestipol prophylaxis (days 1-28) and neratinib dose escalation (DE; ongoing). The primary end point was the incidence of grade ≥3 diarrhea. RESULTS: Final data for loperamide (L; n = 137), budesonide + loperamide (BL; n = 64), colestipol + loperamide (CL; n = 136), and colestipol + as-needed loperamide (CL-PRN; n = 104) cohorts, and interim data for DE (n = 60; completed ≥six cycles or discontinued; median duration 11 months) are available. No grade 4 diarrhea was observed. Grade 3 diarrhea rates were lower than ExteNET in all cohorts and lowest in DE (L 31%, BL 28%, CL 21%, CL-PRN 32%, DE 15%). Median number of grade 3 diarrhea episodes was one; median duration per grade 3 episode was 1.0-2.0 days across cohorts. Most grade 3 diarrhea and diarrhea-related discontinuations occurred in month 1. Diarrhea-related discontinuations were lowest in DE (L 20%, BL 8%, CL 4%, CL-PRN 8%, DE 3%). Decreases in health-related quality of life did not cross the clinically important threshold. CONCLUSIONS: Neratinib tolerability was improved with preemptive prophylaxis or DE, which reduced the rate, severity, and duration of neratinib-associated grade ≥3 diarrhea compared with ExteNET. Lower diarrhea-related treatment discontinuations in multiple cohorts indicate that proactive management can allow patients to stay on neratinib for the recommended time period. CLINICALTRIALS.GOV: NCT02400476

Updated diagnostic criteria and nomenclature for neurofibromatosis type 2 and schwannomatosis: An international consensus recommendation

PURPOSE: Neurofibromatosis type 2 (NF2) and schwannomatosis (SWN) are genetically distinct tumor predisposition syndromes with overlapping phenotypes. We sought to update the diagnostic criteria for NF2 and SWN by incorporating recent advances in genetics, ophthalmology, neuropathology, and neuroimaging. METHODS: We used a multistep process, beginning with a Delphi method involving global disease experts and subsequently involving non-neurofibromatosis clinical experts, patients, and foundations/patient advocacy groups. RESULTS: We reached consensus on the minimal clinical and genetic criteria for diagnosing NF2 and SWN. These criteria incorporate mosaic forms of these conditions. In addition, we recommend updated nomenclature for these disorders to emphasize their phenotypic overlap and to minimize misdiagnosis with neurofibromatosis type 1. CONCLUSION: The updated criteria for NF2 and SWN incorporate clinical features and genetic testing, with a focus on using molecular data to differentiate the 2 conditions. It is likely that continued refinement of these new criteria will be necessary as investigators study the diagnostic properties of the revised criteria and identify new genes associated with SWN. In the revised nomenclature, the term neurofibromatosis 2 has been retired to improve diagnostic specificity

Greater socioenvironmental risk factors and higher chronic pain stage are associated with thinner bilateral temporal lobes

INTRODUCTION: Previous research indicates ethnic/race group differences in pain and neurodegenerative diseases. Accounting for socioenvironmental factors reduces ethnic/race group differences in clinical and experimental pain. In the current study sample, we previously reported that in individuals with knee pain, ethnic/race group differences were observed in bilateral temporal lobe thickness, areas of the brain associated with risk for Alzheimer\u27s disease, and related dementias. The purpose of the study was to determine if socioenvironmental factors reduce or account for previously observed ethnic/race group differences and explore if a combined effect of socioenvironmental risk and chronic pain severity on temporal lobe cortices is evident. METHODS: Consistent with the prior study, the sample was comprised of 147 adults (95 women, 52 men), 45-85 years of age, who self-identified as non-Hispanic Black (n = 72) and non-Hispanic White (n = 75), with knee pain with/at risk for osteoarthritis. Measures included demographics, health history, pain questionnaires, cognitive screening, body mass index, individual- and community-level socioenvironmental factors (education, income, household size, marital and insurance status, and area deprivation index), and brain imaging. We computed a summative socioenvironmental risk index. RESULTS: Regression analyses showed that with the inclusion of socioenvironmental factors, the model was significant (p \u3c .001), and sociodemographic (ethnic/race) group differences were not significant (p = .118). Additionally, findings revealed an additive stress load pattern indicating thinner temporal lobe cortices with greater socioenvironmental risk and chronic pain severity (p = .048). IMPLICATIONS: Although individual socioenvironmental factors were not independent predictors, when collectively combined in models, ethnic/race group differences in bilateral temporal lobe structures were not replicated. Further, combined socioenvironmental risk factors and higher chronic pain severity were associated with thinner bilateral temporal lobes

Applying dissipative dynamical systems to pseudorandom number generation: Equidistribution property and statistical independence of bits at distances up to logarithm of mesh size

The behavior of a family of dissipative dynamical systems representing transformations of two-dimensional torus is studied on a discrete lattice and compared with that of conservative hyperbolic automorphisms of the torus. Applying dissipative dynamical systems to generation of pseudorandom numbers is shown to be advantageous and equidistribution of probabilities for the sequences of bits can be achieved. A new algorithm for generating uniform pseudorandom numbers is proposed. The theory of the generator, which includes proofs of periodic properties and of statistical independence of bits at distances up to logarithm of mesh size, is presented. Extensive statistical testing using available test packages demonstrates excellent results, while the speed of the generator is comparable to other modern generators.Comment: 6 pages, 3 figures, 3 table

Closing the mental health treatment gap in South Africa: a review of costs and cost-effectiveness

PKBackground: Nearly one in three South Africans will suffer from a mental disorder in his or her lifetime, a higher prevalence than many low- and middle-income countries. Understanding the economic costs and consequences of prevention and packages of care is essential, particularly as South Africa considers scalingup mental health services and works towards universal health coverage. Economic evaluations can inform how priorities are set in system or spending changes. Objective: To identify and review research from South Africa and sub-Saharan Africa on the direct and indirect costs of mental, neurological, and substance use (MNS) disorders and the cost-effectiveness of treatment interventions. Design: Narrative overview methodology. Results and conclusions: Reviewed studies indicate that integrating mental health care into existing health systems may be the most effective and cost-efficient approach to increase access to mental health services in South Africa. Integration would also direct treatment, prevention, and screening to people with HIV and other chronic health conditions who are at high risk for mental disorders. We identify four major knowledge gaps: 1) accurate and thorough assessment of the health burdens of MNS disorders, 2) design and assessment of interventions that integrate mental health screening and treatment into existing health systems, 3) information on the use and costs of traditional medicines, and 4) cost-effectiveness evaluation of a range of specific interventions or packages of interventions that are tailored to the national context

Coherent states for the hydrogen atom

We construct wave packets for the hydrogen atom labelled by the classical action-angle variables with the following properties. i) The time evolution is exactly given by classical evolution of the angle variables. (The angle variable corresponding to the position on the orbit is now non-compact and we do not get exactly the same state after one period. However the gross features do not change. In particular the wave packet remains peaked around the labels.) ii) Resolution of identity using this overcomplete set involves exactly the classical phase space measure. iii) Semi-classical limit is related to Bohr-Sommerfield quantization. iv) They are almost minimum uncertainty wave packets in position and momentum.Comment: 9 pages, 2 figures, minor change in language and journal reference adde